Stony Brook Reduces Elective Early-Term Deliveries By 75 Percent
Results part of March of Dimes multi-state study published today in Obstetrics & Gynecology
STONY BROOK, NY, April 8, 2013 – Stony Brook University Hospital (SBUH) has reduced its rate of elective early-term deliveries by 75 percent to lower the risk of serious health problems and deaths for newborns in their first year of life. SBUH is among a group of hospitals nationwide that have significantly reduced their rates, as reported in a study in today’s edition of Obstetrics & Gynecology.
From July 2012 through March 2013, Stony Brook reduced its rate of elective early-term deliveries to 2.8 percent of all scheduled deliveries. This represents a 75 percent reduction compared to a baseline rate of 11.2 percent of scheduled deliveries in 2008, said Adriann Combs, RN, Regional Perinatal Center Coordinator for SBUH.
Stony Brook was one of two New York hospitals participating in the study reported in Obstetrics & Gynecology. Hospitals in five states – New York, Florida, Texas, California and Illinois – reduced their rate of elective early-term deliveries (inductions of labor and Cesarean sections without a medical reason) from 27.8 percent to 4.8 percent during a one-year demonstration period in 2011. Those five states are the five most populous states in the nation, accounting for 38 percent of all live births.
The study results are “good news, because babies delivered before full term are at increased risk of serious health problems and death in their first year of life,” said Nelson S. Andino, New York State Director of Program Services for the March of Dimes, which partially funded the study. He cited the study as an example of the effective partnership between SBUH and the March of Dimes.
Elective early-term deliveries were reduced at Stony Brook through a quality improvement initiative, Combs said. A form was developing for scheduling inductions and Cesarean deliveries, and written guidelines were developed to indicate when patients should be induced for deliveries. Maternal-fetal medicine specialists at Stony Brook now provide consultations and education to physicians regarding patients who do not meet medical indications for delivery prior to 39 weeks’ gestation.
“As Suffolk County’s only regional perinatal center, Stony Brook is leading the effort to educate our patients and physicians on the important health benefits of full-term deliveries,” said J. Gerald Quirk, MD, PhD, Professor in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University School of Medicine. “Reducing unnecessary early deliveries to our patients means that more babies stay in the womb longer, which is vital for their growth and development.”
The issue is complicated by the official definition of “pre-term” babies as those born prior to 37 weeks’ gestation, Combs said. As a result, some healthcare professionals believe that babies born after 37 weeks are considered to be full term. In fact, babies born at 37-38 weeks are considered early-term births, while full-term births are defined as 39 to 41 weeks’ gestation.
Compounding matters, studies have shown that a majority of women believe it is safe to deliver a baby after 36 weeks’ gestation – which Combs said is likely based on a simple but erroneous calculation of nine months of pregnancy multiplied by four weeks for each month. To help address this misperception, healthcare practitioners should define pregnancies to patients in terms of weeks, not months, she said.
Elective inductions can be performed for a variety of legitimate reasons, Combs said, including the mother’s intolerance of late pregnancy, prior labor complications and prior stillbirths. Historically, physicians have scheduled inductions for a variety of reasons, including maximizing their efficiency in handling multiple deliveries during a single visit to the hospital.
As the next step in further reducing its early-term deliveries, Stony Brook is participating in the New York State Partnership for Patients Perinatal Quality Collaborative, Combs said.
“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” said Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.
The study, titled “A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology Vol. 121, No. 5, May 2013 and is available online at http://www.greenjournal.org.
PHOTO CAPTION: With a plaque from the March of Dimes recognizing Stony Brook University Hospital’s participation in a national study to reduce elective early-term deliveries without a medical reason are, left to right: Elizabeth Garduno, MD, and J. Gerald Quirk, MD, PhD, of the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University School of Medicine; Adriann Combs, RN, Regional Perinatal Center Coordinator for Stony Brook University Hospital; and Antonietta Lynch, RN, MS, Clinical Nurse Specialist, Labor and Delivery/Antepartum Units at SBUH.
About the March of Dimes: